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Logo of thijTexas Heart Institute JournalSee also Cardiovascular Diseases Journal in PMCSubscribeSubmissionsTHI Journal Website
Tex Heart Inst J. 2010; 37(5): 505–507.
PMCID: PMC2953220

Dizzy Medical Writing and Editing

Extra Innings
Herbert L. Fred, MD, MACP and Mark S. Scheid, PhD

Twenty-seven years ago, one of us (HLF) helped create a series of “Dizzy Awards”—awards honoring baseball immortal and legendary syntax-mangler Dizzy Dean. The Dizzys are given for excellence in unintentionally comical, bewildering, or downright terrible medical writing.1–5 These awards also recognize poor editing.6–8 The “winners” are excerpts from articles in prominent medical publications.

Last year, we wrote the 9th report in this series.9 Since that time, we have harvested a new crop of winners*:

The Water Cooler Award

“After three hours in the emergency department, the rectal temperature was 37.3 °C.…”

Where was the patient during this time?

The Batty Title Award (5-way tie)

“A 21-Year-Old Male with Dyspnea at Rest, Dry Cough, and Swelling of His Right Anterior Chest”

Presumably his other chest was normal.

“Screening for Prostate Cancer in Long-Term Care”

Does Long-Term Care need to bend over?

“Urinary Tract Infections in Long-Term Care”

How do you get the urine sample?

“Diabetes in the Nursing Home”

Home, Sweet Home

“Nondrug Interventions Improve Memory, Function in Residents with Dementia”

Does it work on interns, too?

The Wrong Ballpark Award (2-way tie)

“Except for one solitary case, acute cardiac dysfunction has not been described previously in alcoholic skeletal myopathy.”

Alcoholic Skeletal Myopathy? I don't think we have that journal.

“To our knowledge, this is the first case of disseminated histoplasmosis in which direct tracheal involvement has been reported.”

Disseminated Histoplasmosis? We don't have that journal either.

The Two Runners on First Award

“A combination of these factors probably have a pathogenic role.”

Is you sure?

The Bad Scouting Report Award

“A follow-up CT scan after 3 months showed an asymptomatic patient with nearly complete regression of the multiple pulmonary nodules.”

Can CT scans ever identify symptoms?

The Who's on First? Award

“Dr. Ash had already attempted to treat the eminent patient with the usual remedies, but his condition was worsening with each passing hour.”

Sorry about Dr. Ash, but what about the patient?

The Double-Play Award

“In this patient, there is a well-defined low-density lesion along the ventral surface of the left tongue.”

And his other tongue?

The Signs from the Coach Award

“SUI, UUI, and MUI were reported in 37%, 31%, and 21%, respectively, and MUI was associated with a greater impact on QoL than either SUI or UUI, independent of age, race, health, or incontinence severity.”


The Scoreboard Award

“The greater pain caused by larger-size tubes was the result of increased pain during the insertion of the tube and pain while the tube was in situ, with no pain difference during tube removal (insertion: size < 10F, MPS 2 [IQR 1–2]; size 10–14F, MPS 2 [IQR 1–3]; size 15–20F, MPS 2 [IQR 1–3]; size > 20F, MPS 2 [IQR 2–3]; χ2, 3 df = 8.12, P = .044, Kruskal-Wallis; χ2 trend, 1 df = 7.2, P =.009. in situ: size < 10F, MPS 2 [IQR 1–3]; size 10–14F, MPS 2 [IQR 1–2]; size 15–20F, MPS 2 [IQR 2–3]; size > 20F, MPS 2 [IQR 2–3]; χ2, 3 df = 11.75, P = .008, Kruskal-Wallis; χ2 trend, 1 df = 6.2, P = .015. removal: size < 10F, MPS 2 [IQR 1–2]; size 10–14F, MPS 1 [IQR 1–2]; size 15–20F, MPS 2 [IQR 1–2]; size > 20F, MPS 1 [IQR 1–2]; χ2, 3 df = 2.7, P = .44, Kruskal-Wallis; χ2 trend, 1 df = 1.0, P = .31 (Fig 2).”

I think we lost.

The Letter-High Curveball Award

“ELF concentrations were 13.7 ± 0.7 for VAN, 2.6 ± 0.1 for TEI, and 10.5 ± 0.7 μg/mL for LZD, and lung concentrations were 5.4 ± 0.1 for VAN, 33.2 ± 21.3 for TEI, and 27.6 ± 12.1 μg/g for LZD.”

The umpires are conferring.

The Out in Left Field Award

“It also highlights the usefulness of BALF in the diagnosis of pulmonary involvement by LCH in a case with a high index of suspicion due to typical radiology and confirmatory histologic diagnosis in an extrapulmonary site.”


The Live Coverage Award

“We believe that this is the 1st report of tumor embolization to the left main coronary artery—and in a living patient.”

Does embolization ever occur in a dead patient?

The Slow-Roller Award (2-way tie)

“To begin requires recognition that identifying and assessing inpatients for postextubation dysphagia requires a multidisciplinary team approach to apply a tiered and standardized evaluation protocol that proceeds from simple screening to more specific diagnostic studies for select patients.”

We can't get there from here.

“If therapeutic anticoagulation can be safely begun in patients with IVC filters inserted after venous thromboembolism, further management with clinical surveillance including ultrasound examination of the IVC filter and graded degrees of anticoagulation therapy if filter clot is detected, has a favorable prognosis.”

By close reading, we were able to there, finally, get.

The Bag of Soda Pop and Bottle of Popcorn Award

“Unlike other systemic rheumatic diseases, the diagnostic criteria for ASOD include a negative test result for ANA and RF.”

Diseases and diagnostic criteria are never alike.

The Blooper Award

“In this issue of, Xxxxxx et al. evaluated 122 consecutive patients who were referred for the evaluation of pulmonary hypertension.”

We recommend that patients be evaluated in settings other than journals.

The Called on Account of Darkness Award

“Mutations in tuberous sclerosis complex (TSC) genes are associated with dysregulated mammalian target of rapamycin (mTOR)/Akt signaling and unusual neoplasms called perivascular epithelioid cell tumors (PEComas), including angiomyolipomas (AMLs) and lymphangioleimyomatosis (LAM).”

We can't see what you're saying.

The Batted Out of Order Award

“Because it is both a common and serious condition, elderly nursing home (NH) residents are….”

The error of the squinting modifier is also both a common and serious condition.

The Rookie of the Year Award

“He had been born in South America and emigrated to the United States several years earlier….”

That's what we call a hyperactive fetus.

The Comeback of the Year Award

“Several years after his death, a former patient and resident of the city sent a letter to the editor of the local newspaper….”

We can't top that!


*Sources available upon request.

Address for reprints: Herbert L. Fred, MD, MACP, 8181 Fannin St., Suite 316, Houston, TX 77054


1. Fred HL, Robie P. Dizzy medical writing. South Med J 1983; 76(9):1165–6. [PubMed]
2. Fred HL, Robie P. Dizzy medical writing: Part II. South Med J 1984;77(6):755–6. [PubMed]
3. Fred HL, Robie P. Dizzy medical writing: concluded. South Med J 1985;78(12):1498–501. [PubMed]
4. Fred HL, Robie P. Dizzy medical writing: report on recent relapses. South Med J 1989;82(7):897–9. [PubMed]
5. Fred HL, Robie P. Dizzy medical writing: will it never end? South Med J 1991;84(6):755–9. [PubMed]
6. Fred HL, Robie P. Dizzy medical editing: causes, consequences, and cures. South Med J 1991;84(6):760–2. [PubMed]
7. Fred HL. Dizzy medical writing and editing: no relief in sight. South Med J 1992;85(7):743–5. [PubMed]
8. Fred HL, Scheid M. Dizzy medical writing and editing: a decade of non-progress. South Med J 1993;86(6):705–9. [PubMed]
9. Fred HL, Scheid MS. Dizzy medical writing and editing: here we go again. Tex Heart Inst J 2009;36(2):86–8. [PMC free article] [PubMed]

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